In this episode, I’ll discuss oral vs IV phosphate replacement for critically ill patients with mild to moderate hypophosphatemia. Episode 914: Does Oral Phosphate Replacement Work as Well as IV For Critically Ill Patients With Mild to Moderate Hypophosphatemia? Subscribe on iTunes, Android, or Stitcher IV phosphate is frequently used to replace low serum phosphate levels in critically ill patients. However this often requires the administration of significant amounts of IV fluid, which can complicate the management of many critical illnesses and is more time consuming and costly than oral adm ..read more

In this episode, I’ll discuss the efficacy tradeoff when reducing apixaban dose in patients with end-stage renal disease. Episode 913: Is there an efficacy tradeoff when reducing apixaban dose in patients with end-stage renal disease? Subscribe on iTunes, Android, or Stitcher The prescribing information for apixaban recommends not reducing the dose when being used in patients with end-stage renal disease and atrial fibrillation. However, renal elimination accounts for 27% of apixaban clearance. This has led some clinicians to reducing the apixaban dose for ESRD patients to 2.5 mg po bid for pr ..read more

In this episode, I’ll discuss whether standard doses of apixaban are as effective as warfarin in severe obesity. Episode 912: Are Standard Doses of Apixaban as Effective as Warfarin in Patients With Severe Obesity? Subscribe on iTunes, Android, or Stitcher Initial studies for apixaban such as ARISTOTLE had a median weight of 82 kg and did not focus on determining efficacy in a severely obese patient population. Because of the lack of inclusion of patients with a BMI 40 and above in the initial approval studies for apixaban, many clinicians avoided use, and guidance statements by professional o ..read more

In this episode, I’ll discuss the risk of bacteremia in patients with asymptomatic bacteriuria and altered mental status. Episode 911: But They Have Altered Mental Status So We Have To Treat Subscribe on iTunes, Android, or Stitcher Perhaps one of the most frustrating scenarios dealing with antimicrobial stewardship is that of a patient with asymptomatic bacteriuria (meaning no systemic signs of infection) but altered mental status. Many clinicians will still want to treat with antibiotics in this case, despite IDSA guidelines giving a strong recommendation to assess “for other causes [of alte ..read more

In this episode, I’ll discuss how to judge whether a journal is reputable. Episode 910: How to judge whether a journal is reputable? Subscribe on iTunes, Android, or Stitcher There are dozens of well-established journals that when we read an article in them, the thought never comes to mind “Is this journal reputable?” But there are also journals with little or even no peer review, low or non-existent academic standards, and scant credibility that exist only to collect author fees from unsuspecting researchers. Here are some ways that an unknown journal can be evaluated to decide whether or not ..read more

In this episode, I’ll discuss a novel metric for antibiotic stewardship. Episode 909: Is this a better metric for antibiotic stewardship? Subscribe on iTunes, Android, or Stitcher Days of Therapy (DOT) is probably the most common metric to track antimicrobial stewardship efforts related to antibiotic consumption. DOT is not a perfect metric as it is calculated by calendar day regardless of the number of doses given, however, it is easily calculated which probably contributes to its popularity. However this metric does not capture all stewardship activities and, if focused on exclusively, could ..read more

In this episode, I’ll discuss the consolidated CHEST guidelines on antithrombotic therapy for venous thromboembolism disease. Episode 908: Finally, All the VTE Recommendations In One Document! Subscribe on iTunes, Android, or Stitcher The CHEST guidelines on venous thromboembolism disease are an invaluable resource, but one flaw that has persisted since 2016 has made referencing the guidelines awkward and inconvenient. When the 1st updated to the 9th edition of the guidelines was published in 2016 the authors chose to only carry forward guidance statements that were new or changed. This meant ..read more

In this episode, I’ll discuss what predicts critical care pharmacist intervention – patient acuity or medication regimen complexity? Episode 907: What predicts critical care pharmacist intervention - patient acuity or medication regimen complexity? Subscribe on iTunes, Android, or Stitcher It makes intuitive sense that both scenarios of high patient acuity and high medication regimen complexity would be legitimate ways of identifying ICU patients who are more likely to need pharmacist intervention. I will often prioritize my day in the ICU by looking first at the patients who appear the sickes ..read more

In this episode, I’ll discuss the mortality rate for critically ill patients when ketamine vs etomidate is used as an induction agent for intubation. Episode 906: Does Using Ketamine for Induction Have a Lower Mortality Rate Than Etomidate? Subscribe on iTunes, Android, or Stitcher Out of the available induction agents for intubation, ketamine is considered to have the best cardiovascular risk profile, as it typically has a neutral to slightly positive effect on heart rate and blood pressure. This may be particularly relevant in critically ill patients, as hemodynamic compromise is a common fa ..read more

In this episode, I’ll discuss which antibiotic should be given first in sepsis – the beta-lactam or the vancomycin? Episode 905: Does It Matter Which Antibiotic You Give First? Subscribe on iTunes, Android, or Stitcher Quickly administering appropriate empiric antibiotic therapy is essential in the treatment of severe infections. If multiple antibiotics are required for empiric therapy to treat a severe infection (such as for empiric coverage of resistant gram-negative and gram-positive organisms), simultaneous administration can be appropriate. However, IV access, antibiotic compatibility, an ..read more